Colonoscopy findings after increasing two-stool faecal immunochemical test (FIT) cut-off: Cross-sectional analysis of the SCREESCO randomized trial

IF 9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2024-06-06 DOI:10.1111/joim.13810
Marcus Westerberg, Julia Eriksson, Chris Metcalfe, Christian Löwbeer, Anders Ekbom, Robert Steele, Lars Holmberg, Anna Forsberg
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Abstract

Background

We determined the impact of an increased two-stool faecal immunochemical test (FIT) cut-off on colonoscopy positivity and relative sensitivity and specificity in the randomized controlled screening trial screening of Swedish colons conducted in Sweden.

Methods

We performed a cross-sectional analysis of participants in the FIT arm that performed FIT between March 2014 and 2020 within the study registered with ClinicalTrials.gov, NCT02078804, who had a faecal haemoglobin concentration of at least 10 µg/g in at least one of two stool samples and who underwent a colonoscopy (n = 3841). For each increase in cut-off, we computed the positive predictive value (PPV), numbers needed to scope (NNS), sensitivity and specificity for finding colorectal cancer (CRC) and advanced neoplasia (AN; advanced adenoma or CRC) relative to cut-off 10 µg/g.

Results

The PPV for AN increased from 23.0% (95% confidence intervals [CI]: 22.3%–23.6%) at cut-off 10 µg/g to 28.8% (95% CI: 27.8%–29.7%) and 33.1% (95% CI: 31.9%–34.4%) at cut-offs 20 and 40 µg/g, respectively, whereas the NNS to find a CRC correspondingly decreased from 41 to 27 and 19. The PPV for AN was higher in men than women at each cut-off, for example 31.5% (95% CI: 30.1%–32.8%) in men and 25.6% (95% CI: 24.3%–27.0%) in women at 20 µg/g. The relative sensitivity and relative specificity were similar in men and women at each cut-off.

Conclusion

A low cut-off of around 20–40 µg/g allows detection and removal of many AN compared to 10 µg/g while reducing the number of colonoscopies in both men and women.

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提高双凳粪便免疫化学检验 (FIT) 临界值后的结肠镜检查结果:SCREESCO 随机试验的横断面分析。
背景:我们确定了在瑞典进行的瑞典结肠随机对照筛查试验中,提高两凳粪便免疫化学检验(FIT)截止值对结肠镜检查阳性率以及相对敏感性和特异性的影响:我们对 2014 年 3 月至 2020 年期间在 ClinicalTrials.gov, NCT02078804 登记的研究中进行了 FIT 试验的 FIT 组参与者进行了横断面分析,这些参与者在两个粪便样本中至少有一个样本的粪便血红蛋白浓度至少为 10 µg/g,并且接受了结肠镜检查(n = 3841)。每提高一个临界值,我们都会计算相对于临界值 10 µg/g 的阳性预测值 (PPV)、所需检查人数 (NNS)、发现结直肠癌 (CRC) 和晚期肿瘤 (AN; 晚期腺瘤或 CRC) 的灵敏度和特异性:AN的PPV从临界值10微克/克时的23.0%(95%置信区间[CI]:22.3%-23.6%)分别增加到临界值20微克/克和40微克/克时的28.8%(95%置信区间:27.8%-29.7%)和33.1%(95%置信区间:31.9%-34.4%),而发现CRC的NNS则相应地从41下降到27和19。在每个临界值下,男性 AN 的 PPV 均高于女性,例如,在 20 µg/g 临界值下,男性为 31.5%(95% CI:30.1%-32.8%),女性为 25.6%(95% CI:24.3%-27.0%)。在每个临界值下,男性和女性的相对敏感性和相对特异性相似:结论:与 10 微克/克相比,20-40 微克/克的低临界值可以检测并清除许多 AN,同时减少男性和女性的结肠镜检查次数。
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来源期刊
Journal of Internal Medicine
Journal of Internal Medicine 医学-医学:内科
CiteScore
22.00
自引率
0.90%
发文量
176
审稿时长
4-8 weeks
期刊介绍: JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.
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